Legal requirements and recommendations to prescribe naloxone
Legal requirements and recommendations to prescribe naloxone
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DOI：
10.1016/j.drugalcdep.2020.107896
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发表时间：
2020-04-01
影响因子：
4.2
通讯作者：
Smart, Rosanna
中科院分区：
文献类型：
--
作者：
Haffajee, Rebecca L.;Cherney, Samantha;Smart, Rosanna
背景资料：阿片类药物相关过量的持续死亡促使人们努力扩大纳洛酮对过量高风险人群的可用性，2016年联邦指南鼓励临床医生向过量风险增加的患者共同开纳洛酮。一些州已经追求类似的或更严格的法律的要求，可能会更严重地影响处方者的行为。方法：我们进行了系统的法律的审查的国家法律，授权或建议医疗服务提供者规定纳洛酮的阿片类药物过量风险的指标的患者。我们编码相关的法规和条例：适用人群，患者标准，教育要求，和exceptions.Results：截至2019年9月，17个州颁布了纳洛酮共同处方法，其中最早的是由路易斯安那州在2016年1月实施。如果符合患者过量风险标准，超过一半的州要求提供者处方纳洛酮（7个州，41.1%）或提供纳洛酮处方（2个州，11.8%）;其余的州鼓励处方者考虑处方纳洛酮（8个州）。大多数国家（58.8%）定义患者用药过量的风险阿片类药物剂量的基础上规定，虽然阈值变化很大;其他常见的过量风险标准包括伴随阿片类药物和苯二氮卓类药物处方和患者的物质使用障碍或精神疾病的历史Conclusions：越来越多的少数国家已通过纳洛酮处方法，虽然这些政策仍然不太普遍比其他纳洛酮访问法律。通过在临床接触期间针对高风险患者，纳洛酮处方要求可以增加纳洛酮处方，消除纳洛酮使用，并减少过量危害。有必要进一步调查政策的有效性、意外后果和适当的参数。
Background: The continued toll of opioid-related overdoses has motivated efforts to expand availability of naloxone to persons at high risk of overdose, with 2016 federal guidance encouraging clinicians to co-prescribe naloxone to patients with increased overdose risk. Some states have pursued analogous or stricter legal requirements that could more heavily influence prescriber behavior.Methods: We conducted a systematic legal review of state laws that mandate or recommend that healthcare providers prescribe naloxone to patients with indicators for opioid overdose risk. We coded relevant statutes and regulations for: applicable populations, patient criteria, educational requirements, and exemptions.Results: As of September 2019, 17 states had enacted naloxone co-prescribing laws, the earliest of which was implemented by Louisiana in January 2016. If patient overdose risk criteria are met, over half of these states mandate that providers prescribe naloxone (7 states, 41.1 %) or offer a naloxone prescription (2 states, 11.8 %); the remainder encourage prescribers to consider prescribing naloxone (8 states). Most states (58.8 %) define patient overdose risk based on opioid dosages prescribed, although the threshold varies substantially; other common overdose risk criteria include concomitant opioid and benzodiazepine prescriptions and patient history of substance use disorder or mental illness.Conclusions: A growing minority of states has adopted a naloxone prescribing law, although these policies remain less prevalent than other naloxone access laws. By targeting higher-risk patients during clinical encounters, naloxone prescribing requirements could increase naloxone prescribed, destigmatize naloxone use, and reduce overdose harms. Further investigation into policy effectiveness, unintended consequences, and appropriate parameters is warranted.